Bottom Line:
Deficits of airway protection can have deleterious effects to health and quality of life.Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway.It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits.

ABSTRACTDeficits of airway protection can have deleterious effects to health and quality of life. Effective airway protection requires a continuum of behaviors including swallowing and cough. Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway. There is significant overlap between the control mechanisms for swallowing and cough. In this review we will present the existing literature to support a novel framework for understanding shared substrates of airway protection. This framework was originally adapted from Eccles' model of cough (2009) by Hegland, et al. (2012). It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits.

Mentions:
Airway protection is functionally complex and includes a continuum of behaviors withcough and swallowing at either end of that continuum (Figure 1). More specifically, effective swallowing prevents material fromentering the airway and effective coughing ejects the aspirate material when airwaycompromise occurs. Both cough and swallowing consist of highly coordinated sequences ofstructural movements, and both require reconfiguration of the ventilatory breathingpattern. There is considerable overlap in the sensory and motor control and execution ofthe two behaviors, including peripheral and central nervous system components. In fact,there is an emerging literature identifying concurrent swallowing and cough deficits inpeople with neurogenic disorders with particular interest in whether cough can predictswallowing dysfunction83,86,100. The purpose of this manuscript is to present a framework forunderstanding the shared mechanisms of cough and swallowing in humans. This frameworkwas originally adapted from Eccles'28(2009) model of cough by Hegland, et al.42 (2012). We now propose further adaptation of the model to includeboth swallowing and cough overlaid into one framework.

Mentions:
Airway protection is functionally complex and includes a continuum of behaviors withcough and swallowing at either end of that continuum (Figure 1). More specifically, effective swallowing prevents material fromentering the airway and effective coughing ejects the aspirate material when airwaycompromise occurs. Both cough and swallowing consist of highly coordinated sequences ofstructural movements, and both require reconfiguration of the ventilatory breathingpattern. There is considerable overlap in the sensory and motor control and execution ofthe two behaviors, including peripheral and central nervous system components. In fact,there is an emerging literature identifying concurrent swallowing and cough deficits inpeople with neurogenic disorders with particular interest in whether cough can predictswallowing dysfunction83,86,100. The purpose of this manuscript is to present a framework forunderstanding the shared mechanisms of cough and swallowing in humans. This frameworkwas originally adapted from Eccles'28(2009) model of cough by Hegland, et al.42 (2012). We now propose further adaptation of the model to includeboth swallowing and cough overlaid into one framework.

Bottom Line:
Deficits of airway protection can have deleterious effects to health and quality of life.Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway.It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits.

ABSTRACTDeficits of airway protection can have deleterious effects to health and quality of life. Effective airway protection requires a continuum of behaviors including swallowing and cough. Swallowing prevents material from entering the airway and coughing ejects endogenous material from the airway. There is significant overlap between the control mechanisms for swallowing and cough. In this review we will present the existing literature to support a novel framework for understanding shared substrates of airway protection. This framework was originally adapted from Eccles' model of cough (2009) by Hegland, et al. (2012). It will serve to provide a basis from which to develop future studies and test specific hypotheses that advance our field and ultimately improve outcomes for people with airway protective deficits.